{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T03:26:14Z","timestamp":1790306774790,"version":"4.1.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Previous studies have highlighted the relationship between socioeconomic inequalities and the general population\u2019s risk of contracting or dying from COVID-19 during the 2020\u22122023 pandemic. In France, socioeconomic inequalities vary across metropolitan areas; few studies have investigated whether this variation explains the spatial disparities observed in COVID-19 incidence and testing rates during the pandemic. We examined the relationship between socioeconomic profiles and these two rates across all 22 metropolitan areas in France for eight of the country\u2019s nine epidemic waves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>For each metropolitan area, we used socioeconomic variables from census data to define socioeconomic profiles through principal component clustering. We then used spatialized generalised additive mixed models to analyze associations between these profiles and both testing and incidence rates, for each epidemic wave from July 2020 to March 2023. Finally, we performed meta-regressions to study the distribution of testing and incidence rate ratios among the various socioeconomically deprived and privileged profiles within each of the 22 metropolitan areas, according to COVID-19 vaccination rate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Testing rates were lower in socioeconomically deprived metropolitan areas than in privileged ones, except during wave 4 (July-October-2021), when testing rates were more similar. Incidence rates were higher in deprived areas (waves 2\u20134, July-2020 to October-2021), but this pattern reversed between waves 6\u20139 (March-2022 to March-2023). Meta-regressions indicated that high vaccination coverage was associated with a narrower gap in testing between deprived and privileged areas. Moreover, for each metropolitan area, the higher the level of deprivation in a zone within the deprived profile, the greater the deprived-privileged gap in under-testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The impact of socioeconomic inequalities on testing and incidence patterns during the COVID-19 pandemic in each metropolitan area in France was driven by the most deprived zones; this impact varied across epidemic waves. Higher vaccination rates and government health measures (lockdowns, mandatory health pass) may have reduced this variation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0348201","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:12:19Z","timestamp":1778281939000},"page":"e0348201","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Socioeconomic inequalities and the COVID-19 pandemic in France: Territorial analyzes based on epidemic wave and metropolitan area"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1351-0257","authenticated-orcid":true,"given":"Luka","family":"Canton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Schalkwijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8619-9775","authenticated-orcid":true,"given":"Jordi","family":"Landier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislas","family":"Rebaudet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilie","family":"Mosnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Handschumacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e8ve","family":"Nauleau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Malfait","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4006-9585","authenticated-orcid":true,"given":"Ludivine","family":"Launay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrille","family":"Delpierre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Kelly-Irving","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabira","family":"Smaili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Vandentorren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9006-5729","authenticated-orcid":true,"given":"Jean","family":"Gaudart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"pone.0348201.ref001","doi-asserted-by":"crossref","first-page":"115319","DOI":"10.1016\/j.socscimed.2022.115319","article-title":"Explaining the deprivation gap in COVID-19 mortality rates: a decomposition analysis of geographical inequalities in England","volume":"311","author":"V Albani","year":"2022","journal-title":"Soc Sci Med"},{"key":"pone.0348201.ref002","doi-asserted-by":"crossref","first-page":"1","DOI":"10.26633\/RPSP.2020.106","article-title":"Inequidades sociales en la progresi\u00f3n de la COVID-19 en poblaci\u00f3n mexicana","volume":"44","author":"L Ortiz-Hern\u00e1ndez","year":"2020","journal-title":"Revista Panamericana de Salud P\u00fablica"},{"issue":"3","key":"pone.0348201.ref003","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1093\/ije\/dyab022","article-title":"Social inequalities and COVID-19 mortality in the city of S\u00e3o Paulo, Brazil","volume":"50","author":"KB Ribeiro","year":"2021","journal-title":"Int J Epidemiol"},{"issue":"9","key":"pone.0348201.ref004","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(21)00160-2","article-title":"Socioeconomic position and the COVID-19 care cascade from testing to mortality in Switzerland: a population-based analysis","volume":"6","author":"J Riou","year":"2021","journal-title":"Lancet Public Health"},{"issue":"6545","key":"pone.0348201.ref005","article-title":"Socioeconomic status determines COVID-19 incidence and related mortality in Santiago, Chile","volume":"372","author":"GE Mena","year":"2021","journal-title":"Science"},{"issue":"1","key":"pone.0348201.ref006","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1186\/s13690-022-00856-9","article-title":"The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020\u20132021","volume":"80","author":"M Meurisse","year":"2022","journal-title":"Arch Public Health"},{"issue":"11","key":"pone.0348201.ref007","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-052888","article-title":"Social inequalities and dynamics of the early COVID-19 epidemic: a prospective cohort study in France","volume":"11","author":"N Bajos","year":"2021","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0348201.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(22)00007-X","article-title":"The effect of social deprivation on the dynamic of SARS-CoV-2 infection in France: a population-based analysis","volume":"7","author":"S Vandentorren","year":"2022","journal-title":"Lancet Public Health"},{"issue":"4","key":"pone.0348201.ref009","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(21)00006-2","article-title":"Factors associated with the spatial heterogeneity of the first wave of COVID-19 in France: a nationwide geo-epidemiological study","volume":"6","author":"J Gaudart","year":"2021","journal-title":"Lancet Public Health"},{"issue":"4","key":"pone.0348201.ref010","doi-asserted-by":"crossref","first-page":"1824","DOI":"10.3390\/ijerph18041824","article-title":"Geographical pattern of COVID-19-related outcomes over the pandemic period in France: a nationwide socio-environmental study","volume":"18","author":"S Deguen","year":"2021","journal-title":"Int J Environ Res Public Health"},{"issue":"9","key":"pone.0348201.ref011","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0256857","article-title":"COVID-19 mortality with regard to healthcare services availability, health risks, and socio-spatial factors at department level in France: a spatial cross-sectional analysis","volume":"16","author":"A Tchicaya","year":"2021","journal-title":"PLoS One"},{"issue":"1","key":"pone.0348201.ref012","doi-asserted-by":"crossref","first-page":"2157","DOI":"10.1186\/s12889-021-12203-8","article-title":"Spatial determinants of excess all-cause mortality during the first wave of the COVID-19 epidemic in France","volume":"21","author":"H Pilkington","year":"2021","journal-title":"BMC Public Health"},{"key":"pone.0348201.ref013","doi-asserted-by":"crossref","first-page":"1162711","DOI":"10.3389\/fpubh.2023.1162711","article-title":"Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region","volume":"11","author":"J Landier","year":"2023","journal-title":"Front Public Health"},{"issue":"4","key":"pone.0348201.ref014","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.3390\/ijerph19042311","article-title":"Can an ecological index of deprivation be used at the country level? The case of the French version of the European Deprivation Index (F-EDI)","volume":"19","author":"O Merville","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0348201.ref015","doi-asserted-by":"crossref","DOI":"10.3389\/fpubh.2024.1313575","article-title":"Reviving health mediation during the COVID-19 crisis and beyond: an implementation study in deprived neighbourhoods of Marseille, France","volume":"12","author":"A Fruleux","year":"2024","journal-title":"Front Public Health"},{"issue":"1","key":"pone.0348201.ref016","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1186\/s12889-023-15917-z","article-title":"Impact of social and demographic factors on the spread of the SARS-CoV-2 epidemic in the town of Nice","volume":"23","author":"E Marin\u00e9 Barjoan","year":"2023","journal-title":"BMC Public Health"},{"key":"pone.0348201.ref017","doi-asserted-by":"crossref","first-page":"1422112","DOI":"10.3389\/fpubh.2024.1422112","article-title":"Spatial distribution of SARS-CoV-2 incidence, social inequality, housing conditions, and density in South-Eastern France: keys for future epidemics","volume":"12","author":"E Marin\u00e9 Barjoan","year":"2024","journal-title":"Front Public Health"},{"issue":"12","key":"pone.0348201.ref018","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1136\/jech-2020-216068","article-title":"Low-income neighbourhood was a key determinant of severe COVID-19 incidence during the first wave of the epidemic in Paris","volume":"75","author":"A-S Jannot","year":"2021","journal-title":"J Epidemiol Community Health"},{"issue":"4","key":"pone.0348201.ref019","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1038\/s41562-021-01079-8","article-title":"A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker)","volume":"5","author":"T Hale","year":"2021","journal-title":"Nat Hum Behav"},{"key":"pone.0348201.ref020","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/1475-9276-12-21","article-title":"A statistical procedure to create a neighborhood socioeconomic index for health inequalities analysis","volume":"12","author":"B Lallou\u00e9","year":"2013","journal-title":"Int J Equity Health"},{"key":"pone.0348201.ref021","unstructured":"ANTICIPE [Internet]. 2025 [cited 2024 Jan 22]. Available from: https:\/\/anticipe.eu\/plateformes\/MAPinMED"},{"key":"pone.0348201.ref022","unstructured":"Institut national de la statistique et des \u00e9tudes \u00e9conomiques (INSEE). D\u00e9finition - IRIS | Insee [Internet]. 2016 [cited 2023 Dec 13]. Available from: https:\/\/www.insee.fr\/fr\/metadonnees\/definition\/c1523"},{"key":"pone.0348201.ref023","article-title":"COVID-19 vaccination at a hospital in Paris: spatial analyses and inverse equity hypothesis","author":"R Val\u00e9ry","year":"2023","journal-title":"medRxiv"},{"key":"pone.0348201.ref024","unstructured":"Bajos N, Costemalle V, Leblanc S, Spire A, Franck JE, Jusot F, et al. Recours \u00e0 la vaccination contre le Covid- 19: de fortes disparit\u00e9s sociales [Internet]. 2022 [cited 2023 Nov 20]. Available from: https:\/\/drees.solidarites-sante.gouv.fr\/publications-communique-de-presse\/etudes-et-resultats\/recours-la-vaccination-contre-le-covid-19-de"},{"issue":"1","key":"pone.0348201.ref025","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s43856-023-00257-1","article-title":"Estimating COVID-19 vaccine uptake and its drivers among migrants, homeless and precariously housed people in France","volume":"3","author":"T Roederer","year":"2023","journal-title":"Commun Med (Lond)"},{"key":"pone.0348201.ref026","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1186\/s12889-022-13127-7","article-title":"Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review","volume":"22","author":"M Embrett","year":"2022","journal-title":"BMC Public Health"},{"issue":"16","key":"pone.0348201.ref027","doi-asserted-by":"crossref","first-page":"9973","DOI":"10.3390\/ijerph19169973","article-title":"The challenge of reaching undocumented migrants with COVID-19 vaccination","volume":"19","author":"SA Matlin","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0348201.ref028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41467-022-30895-3","article-title":"Duration of mRNA vaccine protection against SARS-CoV-2 Omicron BA.1 and BA.2 subvariants in Qatar","volume":"13","author":"H Chemaitelly","year":"2022","journal-title":"Nat Commun"},{"issue":"1","key":"pone.0348201.ref029","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1038\/s41392-022-00997-x","article-title":"SARS-CoV-2 Omicron variant: recent progress and future perspectives","volume":"7","author":"Y Fan","year":"2022","journal-title":"Signal Transduct Target Ther"},{"issue":"1","key":"pone.0348201.ref030","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1186\/s12889-021-10521-5","article-title":"When lockdown policies amplify social inequalities in COVID-19 infections: evidence from a cross-sectional population-based survey in France","volume":"21","author":"N Bajos","year":"2021","journal-title":"BMC Public Health"},{"issue":"7","key":"pone.0348201.ref031","doi-asserted-by":"crossref","DOI":"10.2196\/27768","article-title":"Early acceptability of a mobile app for contact tracing during the COVID-19 pandemic in France: national web-based survey","volume":"9","author":"R Touzani","year":"2021","journal-title":"JMIR Mhealth Uhealth"},{"issue":"23","key":"pone.0348201.ref032","doi-asserted-by":"crossref","DOI":"10.1126\/sciadv.abc0764","article-title":"Mobile phone data for informing public health actions across the COVID-19 pandemic life cycle","volume":"6","author":"N Oliver","year":"2020","journal-title":"Sci Adv"},{"key":"pone.0348201.ref033","first-page":"3123","article-title":"Country-wide Mobility Changes Observed Using Mobile Phone Data During COVID-19 Pandemic.","volume-title":"2020 IEEE International Conference on Big Data (Big Data) [Internet]","author":"G Heiler","year":"2020"},{"key":"pone.0348201.ref034","article-title":"Geoepidemiology of COVID-19 hospitalisations and severity: impact of social deprivation and remote areas, in the south-eastern region, France","author":"P Garneret","year":"2025","journal-title":"medRxiv"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T23:12:29Z","timestamp":1778281949000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0348201"}},"subtitle":[],"editor":[{"given":"Anton","family":"Pak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":34,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0348201","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]}}}